Forms & Documents > Public Health HIPAA Authorizations and Other Related Forms

Name Description Type Action
HIPAA-Incident-Report_Public-Health HIPAA Incident Report Form - Public Health File Download
ROI-FILLABLE - Clinics / LEMC Authorization to Disclose PHI from Clinics or LEMC. (ROI Public Health HIPAA) File Download
ROI_Cell-side-visit_LEMC Authorization to Disclose PHI in the Presence of Other Inmates. (ROI Public Health HIPAA) File Download
CCS-MISP-ROI - FILLABLE Authorization to disclose PHI from the CCS Program or MISP Program. (ROI Public Health HIPAA) File Download
ROI-For-information-FROM-another-entity-PASO-PH Authorization to request information from another entity - Paso Clinic. (ROI Public Health HIPAA) File Download
GENERIC-ROI-Can-be-used-for-any-purpose-in-any-division Generic Authorization to Share Information. (ROI Public Health HIPAA) File Download